4.18.2009

Intangibles

I suppose the residents and students think it’s some kind of personality quirk but each time we enter an ICU room to examine a really sick patient who is obviously obtunded - out of it, I first take their hand (after washing mine, of course), smile and tell them we are going to talk shop about what we need to do today to make them better. Before we leave the room I repeat the ritual and tell them we’ll see them later. It slows down rounds a bit but I don’t care. I also insist that when they present to me that they use the patient’s formal name as they speak. I’ve performed this ritual for more than 20 years now. The seed for this was planted on the very first day of my internship.

I came to work that day beaming with pride and excitement. I’d landed a residency position at a very prestigious surgery program. It was my first choice. I’d done so may clerkships at this hospital that many people thought I was already a resident. The excitement turned to abject terror over the next few hours as I was introduced to my first rotation - cardiothoracic surgery. I was the only intern assigned that month to a cardiac service with 5 busy surgeons performing 7 - 11 major cases per day. I was responsible for rounding on all their ICU patients - they had their own ICU of more than 20 beds. I pretty much lived there for that month.

And on that first day I saw her for the first time. I was told it was a her though from the bedside it was hard to tell. In the bed before me was a middle-aged woman who had had a heart attack that rendered her heart incapable of sustaining her life. Whether she would recover was doubtful. For now she was on every device and drug known to man trying to keep her alive from moment to moment. She was heavily sedated and had the very glassy eyed look of the very sick. She didn’t seem to respond to any stimulus except in a sort of reflexive manner. As the macabre saying goes, ‘the lights were on but nobody was home’. She was on a ventilator. From the artery in her left groin, an intra-aortic balloon pump threaded into her chest received a burst of nitrogen that inflated it each time the valve between her heart and aorta closed.

From her open chest cavity you could see her heart beating under the dressings. Two large tubes took blood from her right heart, circulated it through a VAD, a ventricular assist device; essentially an artificial heart, and returned it to her body. A similar set did the same to her left heart. Tubes and catheters tracked from her bladder, her stomach. It seemed nightmarish to me at the time.

And I had to examine her and care for her each day. I was scared to death of doing something wrong. Where to begin an exam on such a patient. Each morning I started rounds at her bedside. Being in over my head and completely clueless as to what I should be doing, I guess I reverted to the simple defense mechanism of smiles and pleasantry which allowed me to gain favor with the nurses who knew so much more than I did. As they guided me in my assessment I instinctively grabbed the patient’s hand and smiled as they gave me report and nudged me in the right directions. It was nothing but instinct - one that served me well. This went on for almost 3 weeks. Surprisingly she slowly recovered, came off all the support devices and went off to the ward to mend though she was still very obtunded and unable to think clearly. I went off service and that was that.

Well, not quite. Three years later I was walking down a long hall that separated an old part of the campus from the new. I had learned a lot in those years but had been humbled many more times as well. Nevertheless, I had reached a point when I could actually provide some reasonable care. I was not having a good day. I was having some second thoughts about whether this path was for me. I wasn’t all that sure that I was doing any good.

That hall was one of my favorite parts of the hospital. Out the window was this old smoke stack that no longer had any purpose. From its top grew this little tree. Administration always wanted to cut it but it had become our mascot - a symbol of life’s endless ability to endure. Not a bad symbol for a hospital. I was walking and smiling to myself as I looked out at that tree.

From the opposite direction a gaggle of suits was trotting along behind the CEO of the hospital and some woman of obvious import to the suits. Normally, I wouldn’t have given it much thought but the woman with the suits was absolutely stunning. She was one of those people who was both beautiful but also radiated grace, power and intelligence by the way she walked down the hall with an elegant stride that reminded me of the way a great cat glides along.

She was explaining something to the suits when I caught her eye and she stopped mid-sentence. She walked over to me and said the first astonishing thing; “Dr, [pliny], is that you?” I fumbled a simple affirmative and (doing the second astonishing thing) she immediately hugged me tightly. Not being used to such attention by Sophia Loren types, I was a bit off my game.

She said, “You don’t recognize me do you?”. Before I could grab the shovel to dig myself deeper, she graciously said the most astonishing thing of all. “I’m so and so”. Being the slick guy that I am, I uttered, “No Way!” She laughed and hugged me again. The CEO and the suit minions were a bit perplexed and uncomfortable by now, so she explained to them while never taking her eyes away from mine.

“I was hoping I’d get to see you and thank you for saving my life.”

I started to correct her as to my extraordinarily limited contribution when she stopped me.

“I was so sick and was afraid I was going to die. But each morning you would walk in with a big smile and I knew I would make it one more day. As long as you were smiling I was going to make it.”

I was shaken to the bone. Me, lowly and least of all the people who cared for this woman who obviously was more awake than we dared imagine, had become her link back from the edge. I learned the power of small things and seemingly trivial kindnesses in that moment.

I never saw her again, except in the face of every sick patient for more than 20 years...

7 comments:

For a guy who claims to not know or believe in God, you sure act like Him.

On behalf of my God and His people I ask for your forgiveness. As a people we must have misrepresented our God terribly if someone such as yourself can intuit and practice His true nature so well and not see the same in us.

Wow. Heartwarming story. And also an important point of view, because patients tend to do better if they have doctors who are attentive, not just in providing treatment, but comfort as well. They are very much in need of reassurance, because their conditions are bad enough without having to feel as if you are abandoned and uncared for by the very people who are trying to attend to that condition. It's good that you are able to provide that for them.

Those of us who have been privileged to have a career in a profession that provides daily opportunities to really "help" our fellows salute you! Although it is unlikely that any of your readers who have never worked as physicians or nurses can fully appreciate the medical issues you describe, I am sure that all of them will detect the sincerity and true dedication to humanity that comes thorugh so clearly in your story. As a fewllow surgeon (and unbeliever) I would hope that Christians other than Michael Lockridge will read it and let it help them to understand that one can be caring and dedicated to one's fellows' well being, and even "moral" in the very best sense of the word without necessarily requiring direction from some "higher" authority.

Thanks to all for you very kind comments (Far too kind in fact). My wife has been after me for some time to start recording some of my experiences and the events that shaped my career. It was good to start with this one because in my mind at least, this incident provided the clearest example of the goals I needed to set as a physician. It was a strange encounter but an unforgettable lesson. I have not always been successful at living up to these ideals, but I try as best I can.

Our greatest privilege is sometimes relieving or at least reducing another's burden. And the relief we may provide may not be a surgery or a treatment but just an ally to some frightened soul.

I fear that at least some of this is being lost in all the hoopla of costs, insurance, electronic records, you name it.

The Snoah ball

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